SynopsisCodesLook ForDiagnostic PearlsDifferential Diagnosis & PitfallsBest TestsManagement PearlsTherapyReferences
Emergency: requires immediate attention
Spinal cord compression
Other Resources UpToDate PubMed
Emergency: requires immediate attention

Spinal cord compression

Contributors: Andrea Wasilewski MD, Christine Osborne MD, Jamie Adams MD, Richard L. Barbano MD, PhD
Other Resources UpToDate PubMed


Spinal cord compression refers to external mechanical compression of the spinal cord. It can be caused by different processes. It is considered a medical emergency, as it can result in permanent loss of neurologic function. Signs and symptoms vary depending on the level of spinal cord involvement and may include weakness, loss of sensation, urinary or stool incontinence, and/or localized pain.

The most common causes of spinal cord compression include the following:
  • Malignant spinal cord compression – This is considered an oncologic emergency. It is due to extradural tumor compression. 5%-10% of patients with cancer will experience spinal cord compression; the most common cancers responsible are lung, breast, and prostate cancers, and the most common sites of involvement are the thoracic spine (70%) followed by the lumbar spine (20%) and the cervical spine (10%).
  • Spinal epidural abscess – Often presents with midline back or neck pain, fever, and weakness and may progress to irreversible motor and sensory deficits if not promptly treated. Risk factors include immunodeficiency, intravenous (IV) drug use, and impaired skin integrity (including recent surgery). Commonly implicated organisms include Staphylococcus aureus, gram-negative bacilli, Streptococcus, anaerobes, fungi, and tuberculosis-causing Pott disease.
  • Spinal epidural hematoma – Hemorrhage into the epidural or subdural space causes acute focal or radicular pain followed by symptoms of spinal cord compression. Risk factors include trauma, therapeutic anticoagulation, and underlying blood dyscrasias. Spinal epidural hematoma may be a complication of lumbar puncture or epidural anesthesia.
  • Hematomyelia – Hemorrhage into the spinal cord itself, resulting in acute painful transverse myelopathy. Risk factors include trauma, vascular malformations, vasculitis due to systemic lupus erythematosus or polyarteritis nodosa, bleeding disorders, and spinal cord neoplasms.
  • Degenerative spine conditions, especially cervical spondylosis; ruptured disks; and trauma with bony dislocation.


G95.20 – Unspecified cord compression

71286001 – Spinal cord compression

Look For

Subscription Required

Diagnostic Pearls

Subscription Required

Differential Diagnosis & Pitfalls

  • Disk herniation (see Cervical radiculopathy, Lumbar radiculopathy)
  • Spinal stenosis (see Cervical spinal stenosis, Lumbar spinal stenosis)
  • Spinal cord injury / trauma / fracture
  • Spinal cord infarction
  • Spinal arteriovenous malformation
  • Cauda equina syndrome
  • Multiple sclerosis
  • Transverse myelitis
  • Neuromyelitis optica spectrum disorder
  • Sarcoidosis
  • Spinal infections (eg, West Nile virus)
  • Vertebral Osteomyelitis
  • Ankylosing spondylitis
  • Spondylolisthesis
  • Amyotrophic lateral sclerosis
  • Aortic dissection

Best Tests

Subscription Required

Management Pearls

Subscription Required


Subscription Required


Subscription Required

Last Reviewed:03/15/2018
Last Updated:05/31/2023
Copyright © 2024 VisualDx®. All rights reserved.
Emergency: requires immediate attention
Spinal cord compression
Copyright © 2024 VisualDx®. All rights reserved.